Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferiores

Detalhes bibliográficos
Autor(a) principal: De Souza, Edvaldo [UNIFESP]
Data de Publicação: 2001
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da UNIFESP
dARK ID: ark:/48912/001300000jxvm
Texto Completo: http://repositorio.unifesp.br/handle/11600/17618
Resumo: Introduction: The deep vein thrombosis (DVT) has as serious complications lung embolism, important cause of mortality, and post-thrombosis syndrome ,the most frequent cause of chronic vein stasis of the lower limbs. The signs and clinical symptoms of DVT present a high rate of false-positive and false-negative, when compared to objective methods of diagnosis. The correct diagnosis of DVT, confirmed by phlebography or other non-invasive methods , permits the appropriate treatment with anticoagulants, reducing the incidence of lung embolism and minimizing chronic vein stasis. It also avoids the unnecessary exposure to the risks of anticoagulant therapy in the negative cases. With the indiscriminate use of subsidiary exams, the incidence of negative exams has increased, reducing the cost-benefit of these diagnostic methods. Philip S. Wells, of the University of Ottawa, Canada, in 1995 and 1997, proposed a method of clinical prediction for the diagnosis of DVT, and he concluded that it is possible to stratify groups accurately into high, moderate and low probability, rationalizing the use of supplementary diagnostic methods, method that needs validation in other centers, as suggested by the author himself. Objective: To test the hypothesis that the model of clinical prediction proposed by Wells is capable of stratifying the patients into groups of high, moderate and low probability of DVT of the lower limbs. Method: Prospective study, including 111 consecutive patients, 114 members, with signs and symptoms of DVT in the lower limbs. Of these, 99 carried out phlebography, resulting in 102 extremities studied. The patients were examined according to the order of their arrival in the hospital or by the request of intra-hospital evaluation of patients admitted for other reasons. A postgraduate student of vascular surgery, a second year resident of General Surgery, and a second year medical student, who had never had contact with patients with DVT, filled out forms based on the proposal by Wells, and would not have further contact with the examined patient. The phlebography were carried out by doctors that didn`t know about the forms and were just interpreted at the end of the study, by three other assisting doctors that didn`t know the identity of the patients and had not participated in the treatment or previous evaluation. Results: In 65 (63,7%) of the 102 lower limbs the presence of DVT was proven by phlebography. The clinical model of Wells demonstrated a prevalence of DVT of 85,5% in the category of high probability, 50% in the group of moderate probability and 25% in the category of low probability. The location of DVT was proximal, starting from the popliteal vein, by 80,6%, 25% and 12,5%, while it was located exclusively in the veins of the calf by 4,8%, 25,0% and 12,5%, in the high, moderate and low probability groups, respectively. The coefficient of reproducibility of Cronbach among the postgraduate, the resident and the student was 86,3%. Conclusion: The model of clinical prediction of DVT proposed by Wells allows adequate identification of patients with high probability and with DVT proximal. However, the method is unsatisfactory for the identification of DVT in the patients allocated in the moderate and low probability groups.
id UFSP_c925bcf84f47441f78b8a706f1f44dc5
oai_identifier_str oai:repositorio.unifesp.br/:11600/17618
network_acronym_str UFSP
network_name_str Repositório Institucional da UNIFESP
repository_id_str 3465
spelling Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferioresValidation of clinical model for the diagnosis of lower extremity deep vemous trombosisDiagnósticoEmbolia PulmonarFatores de RiscoSíndrome Pós-FlebíticaTromboemboliaTrombose VenosaIntroduction: The deep vein thrombosis (DVT) has as serious complications lung embolism, important cause of mortality, and post-thrombosis syndrome ,the most frequent cause of chronic vein stasis of the lower limbs. The signs and clinical symptoms of DVT present a high rate of false-positive and false-negative, when compared to objective methods of diagnosis. The correct diagnosis of DVT, confirmed by phlebography or other non-invasive methods , permits the appropriate treatment with anticoagulants, reducing the incidence of lung embolism and minimizing chronic vein stasis. It also avoids the unnecessary exposure to the risks of anticoagulant therapy in the negative cases. With the indiscriminate use of subsidiary exams, the incidence of negative exams has increased, reducing the cost-benefit of these diagnostic methods. Philip S. Wells, of the University of Ottawa, Canada, in 1995 and 1997, proposed a method of clinical prediction for the diagnosis of DVT, and he concluded that it is possible to stratify groups accurately into high, moderate and low probability, rationalizing the use of supplementary diagnostic methods, method that needs validation in other centers, as suggested by the author himself. Objective: To test the hypothesis that the model of clinical prediction proposed by Wells is capable of stratifying the patients into groups of high, moderate and low probability of DVT of the lower limbs. Method: Prospective study, including 111 consecutive patients, 114 members, with signs and symptoms of DVT in the lower limbs. Of these, 99 carried out phlebography, resulting in 102 extremities studied. The patients were examined according to the order of their arrival in the hospital or by the request of intra-hospital evaluation of patients admitted for other reasons. A postgraduate student of vascular surgery, a second year resident of General Surgery, and a second year medical student, who had never had contact with patients with DVT, filled out forms based on the proposal by Wells, and would not have further contact with the examined patient. The phlebography were carried out by doctors that didn`t know about the forms and were just interpreted at the end of the study, by three other assisting doctors that didn`t know the identity of the patients and had not participated in the treatment or previous evaluation. Results: In 65 (63,7%) of the 102 lower limbs the presence of DVT was proven by phlebography. The clinical model of Wells demonstrated a prevalence of DVT of 85,5% in the category of high probability, 50% in the group of moderate probability and 25% in the category of low probability. The location of DVT was proximal, starting from the popliteal vein, by 80,6%, 25% and 12,5%, while it was located exclusively in the veins of the calf by 4,8%, 25,0% and 12,5%, in the high, moderate and low probability groups, respectively. The coefficient of reproducibility of Cronbach among the postgraduate, the resident and the student was 86,3%. Conclusion: The model of clinical prediction of DVT proposed by Wells allows adequate identification of patients with high probability and with DVT proximal. However, the method is unsatisfactory for the identification of DVT in the patients allocated in the moderate and low probability groups.Introdução: A trombose venosa profunda (TVP) tem como graves complicações a embolia pulmonar - causa importante de mortalidade -, e a síndrome pós-trombótica - causa mais freqüente de estase venosa crônica dos membros inferiores. Os sinais e sintomas clínicos da TVP apresentam uma elevada taxa de falso-positivo e falso-negativo, quando comparada a métodos objetivos de diagnóstico. O diagnóstico correto da TVP, confirmado pela flebografia ou outros métodos não-invasivos, propicia o tratamento adequado com anticoagulantes, reduzindo a incidência de embolia pulmonar e minimizando a estase venosa crônica. Também evita a exposição desnecessária aos riscos da terapia anticoagulante nos casos negativos. Com o uso indiscriminado de exames subsidiários, a incidência de exames negativos tem aumentado, reduzindo o custo-benefício desses métodos diagnósticos. Philip S. Wells, da Universidade de Ottawa, Canadá, em 1995 e 1997, propôs um método de predição clínica para o diagnóstico de TVP e concluiu que é possível estratificar com precisão grupos de alta, moderada e baixa probabilidades, racionalizando o uso dos métodos diagnósticos complementares, que necessitam de validação em outros centros, conforme sugerido pelo próprio autor. Objetivo: Testar a hipótese de que o modelo de predição clínica proposto por Wells é capaz de estratificar os pacientes em grupos de alta, moderada e baixa probabilidades para TVP dos membros inferiores. Método: Estudo prospectivo, incluindo 111 pacientes consecutivos, 114 membros, com sinais e sintomas de TVP nos membros inferiores. Destes, 99 realizaram flebografia, resultando em 102 extremidades estudadas. Os pacientes foram examinados por ocasião da chegada ao hospital ou por solicitação da valiação intra-hospitalar de pacientes internados por outros motivos. Um pós-graduando da Cirurgia Vascular, um residente do 2o ano da Cirurgia Geral e um aluno do 2o ano da graduação em Medicina, que nunca teve contato com pacientes com TVP, preencheram um formulário baseado no proposto por Wells, e não tiveram mais contato com o paciente examinado. As flebografias foram realizadas por médicos que desconheciam o formulário e interpretadas apenas no final do estudo por três outros médicos assistentes que desconheciam a identificação dos pacientes e não haviam participado do tratamento ou avaliação anterior. Resultados: Em 65 (63,7%) dos 102 membros inferiores, ficou comprovada pela flebografia a presença de TVP. O modelo clínico de Wells demonstrou uma prevalência de TVP de 85,5% na categoria de alta probabilidade, 50% no grupo de moderada probabilidade e 25% na categoria de baixa probabilidade. A localização da TVP foi proximal, a partir da veia poplítea, em 80,6%, 25,0% e 12,5%, enquanto foi localizada exclusivamente nas veias da panturrilha em 4,8%, 25,0% e 12,5%, nos grupos de alta, moderada e baixa probabilidades, respectivamente. O coeficiente de reprodutibilidade de Cronbach entre o pós-graduando, o residente e o aluno foi de 86,3%. Conclusão: O modelo de predição clínica de TVP proposto por Wells permite identificar adequadamente pacientes de alta probabilidade e com TVP proximal. Entretanto, o método é insatisfatório para a identificação da TVP nos pacientes alocados nos grupos de moderada e baixa probabilidades.BV UNIFESP: Teses e dissertaçõesUniversidade Federal de São Paulo (UNIFESP)Figueiredo, Luiz Francisco Poli de [UNIFESP]De Souza, Edvaldo [UNIFESP]2015-12-06T23:01:49Z2015-12-06T23:01:49Z2001info:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/publishedVersion126 p.application/pdfDE SOUZA, Edvaldo. Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferiores. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2001.Tese-6758.pdfhttp://repositorio.unifesp.br/handle/11600/17618ark:/48912/001300000jxvmporinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-04T10:56:56Zoai:repositorio.unifesp.br/:11600/17618Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-12-11T20:22:05.352748Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferiores
Validation of clinical model for the diagnosis of lower extremity deep vemous trombosis
title Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferiores
spellingShingle Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferiores
De Souza, Edvaldo [UNIFESP]
Diagnóstico
Embolia Pulmonar
Fatores de Risco
Síndrome Pós-Flebítica
Tromboembolia
Trombose Venosa
title_short Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferiores
title_full Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferiores
title_fullStr Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferiores
title_full_unstemmed Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferiores
title_sort Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferiores
author De Souza, Edvaldo [UNIFESP]
author_facet De Souza, Edvaldo [UNIFESP]
author_role author
dc.contributor.none.fl_str_mv Figueiredo, Luiz Francisco Poli de [UNIFESP]
dc.contributor.author.fl_str_mv De Souza, Edvaldo [UNIFESP]
dc.subject.por.fl_str_mv Diagnóstico
Embolia Pulmonar
Fatores de Risco
Síndrome Pós-Flebítica
Tromboembolia
Trombose Venosa
topic Diagnóstico
Embolia Pulmonar
Fatores de Risco
Síndrome Pós-Flebítica
Tromboembolia
Trombose Venosa
description Introduction: The deep vein thrombosis (DVT) has as serious complications lung embolism, important cause of mortality, and post-thrombosis syndrome ,the most frequent cause of chronic vein stasis of the lower limbs. The signs and clinical symptoms of DVT present a high rate of false-positive and false-negative, when compared to objective methods of diagnosis. The correct diagnosis of DVT, confirmed by phlebography or other non-invasive methods , permits the appropriate treatment with anticoagulants, reducing the incidence of lung embolism and minimizing chronic vein stasis. It also avoids the unnecessary exposure to the risks of anticoagulant therapy in the negative cases. With the indiscriminate use of subsidiary exams, the incidence of negative exams has increased, reducing the cost-benefit of these diagnostic methods. Philip S. Wells, of the University of Ottawa, Canada, in 1995 and 1997, proposed a method of clinical prediction for the diagnosis of DVT, and he concluded that it is possible to stratify groups accurately into high, moderate and low probability, rationalizing the use of supplementary diagnostic methods, method that needs validation in other centers, as suggested by the author himself. Objective: To test the hypothesis that the model of clinical prediction proposed by Wells is capable of stratifying the patients into groups of high, moderate and low probability of DVT of the lower limbs. Method: Prospective study, including 111 consecutive patients, 114 members, with signs and symptoms of DVT in the lower limbs. Of these, 99 carried out phlebography, resulting in 102 extremities studied. The patients were examined according to the order of their arrival in the hospital or by the request of intra-hospital evaluation of patients admitted for other reasons. A postgraduate student of vascular surgery, a second year resident of General Surgery, and a second year medical student, who had never had contact with patients with DVT, filled out forms based on the proposal by Wells, and would not have further contact with the examined patient. The phlebography were carried out by doctors that didn`t know about the forms and were just interpreted at the end of the study, by three other assisting doctors that didn`t know the identity of the patients and had not participated in the treatment or previous evaluation. Results: In 65 (63,7%) of the 102 lower limbs the presence of DVT was proven by phlebography. The clinical model of Wells demonstrated a prevalence of DVT of 85,5% in the category of high probability, 50% in the group of moderate probability and 25% in the category of low probability. The location of DVT was proximal, starting from the popliteal vein, by 80,6%, 25% and 12,5%, while it was located exclusively in the veins of the calf by 4,8%, 25,0% and 12,5%, in the high, moderate and low probability groups, respectively. The coefficient of reproducibility of Cronbach among the postgraduate, the resident and the student was 86,3%. Conclusion: The model of clinical prediction of DVT proposed by Wells allows adequate identification of patients with high probability and with DVT proximal. However, the method is unsatisfactory for the identification of DVT in the patients allocated in the moderate and low probability groups.
publishDate 2001
dc.date.none.fl_str_mv 2001
2015-12-06T23:01:49Z
2015-12-06T23:01:49Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format masterThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv DE SOUZA, Edvaldo. Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferiores. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2001.
Tese-6758.pdf
http://repositorio.unifesp.br/handle/11600/17618
dc.identifier.dark.fl_str_mv ark:/48912/001300000jxvm
identifier_str_mv DE SOUZA, Edvaldo. Validação de modelo de predição clínica para o diagnóstico de trombose venosa profunda dos membros inferiores. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2001.
Tese-6758.pdf
ark:/48912/001300000jxvm
url http://repositorio.unifesp.br/handle/11600/17618
dc.language.iso.fl_str_mv por
language por
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 126 p.
application/pdf
dc.publisher.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
publisher.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
instacron:UNIFESP
instname_str Universidade Federal de São Paulo (UNIFESP)
instacron_str UNIFESP
institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
_version_ 1818602475280662528